Community-based palliative care service provision framework (PALLIUM framework) in a resource-limited setting

Palliative care addresses the complex needs of individuals with life-limiting illnesses (LLIs), encompassing physical, psychological, social and spiritual dimensions of suffering. In India, access to such care remains extremely limited, with less than 4% of those in need receiving it. Existing services often focus narrowly on pain relief, neglecting the broader concept of 'total pain'. Moreover, community-based delivery models that address these holistic needs within resource-constrained environments are largely missing.

This case report describes the development and structure of a community-based palliative care framework implemented by Pallium India, a leading non-profit organisation in the field. Using a modified Delphi method, the framework was developed through iterative discussions with clinical and non-clinical team members, incorporating expert consultations and consensus-building exercises. The resulting model outlines a decision-making flowchart for identifying eligibility, determining care pathways and integrating psychosocial support. Care is delivered through home visits, outpatient clinics, inpatient units or telehealth, depending on the severity of symptoms and geographical access. The framework includes provisions for individuals with diagnostic uncertainty, linking them to higher centers when feasible or offering provisional support. It actively addresses non-medical needs through interventions such as education support, housing repairs and vocational rehabilitation. Social officers assess and address financial and community-based needs and referrals are made to local services when appropriate.

The Pallium India framework presents a comprehensive, equitable and context-sensitive approach to community-based palliative care. It emphasises early identification, telehealth integration, interdisciplinary care and strong community linkages. While not yet formally evaluated for outcomes such as quality of life or cost-effectiveness, the framework represents a scalable and sustainable model for resource-limited settings. Its design aligns with public health principles of equity, community participation and multisectoral collaboration, offering a promising strategy to bridge the current palliative care gap in India and other low-resource regions.